CD4 count drop to half but still undetectable viral charge... why?

Jun 29, 2014

Dear Dr. Young,
I have been on this fórum other times and have found your answers very helpful as well as reassuring.
I have been on Prezista, Norvir and Truvada for about 2.5 years. Have only missed a dose once in January 2013. My viral load was about 5,000 to begin with and went undetectable after about 6 months, however my CD4 count (which also started very low) started at 211 and 11% has been growing very slowly, always showing numbers in the mid 400's to mid 500's with and escalating percentage up to the mid 30's.
Two doctor's visits ago, inn February 2014 my CD4 count was up to 855 with a percentage of 37% and I was ecstatic. HOWEVER, I went back yesterday and it had dropped to almost half. It is now at 475 and the percentage dropped 2 points as well.
My doctor asked if I had had any acute infectious processes, flu, gastrointestinal issues, fever, etc. I HAVE NOT had anything but one UTI about a week before blood work. What I HAVE had a lot of is stress, anxiety and sleepless nights because I am changing jobs, cities, dealing with some family issues and I have to leave my doctor (who's been taking care of me for nearly 14 years), etc. So he said not to give it too much thought, that it isn't anything determining as everything else is great, undetectable viral load and all bloodwork are perfect. He in fact showed me the graphs and said that if we were to ignore that visit in February, everything would be showing a very stable line, but I worry about such a big drop and also those 2 points in decrease on the percentage...
So my question is: should I be worried that something is up? could this be a sign the meds aren't working?
I am scheduled to go in again in December 2014.
Thank you for your time and dedication. We are very fortunate to have this site to resort to as well as the great doctors and advisors who "make everything better" by calming our worries and educating us.
Again, thank you!
E

Response from Dr. Holodniy

I agree with your doctor's assessment and I would not be concerned about one blood test result, given that the viral load remains undetectable and the CD4 percent only declined 2% which is within assay variability. It is likely your total white blood cell count (WBC) and lymphocyte count decreased for whatever reason, which is contributing to the CD4 decline.

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